BSN as entry into practice; why we decided against it.
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While hopefully avoiding stoking the ADN - BSN debate unnecessarily, I thought I'd share my experience with my state's consideration of BSN as entry into practice, as well as the BSN-in-10... Read More

MunroRN, your contention that only hospitals affiliated with BSN granting Universities prefer BSN's not only sounds like a conspiracy theory, it doesn't reflect reality.

EVERY hospital in Denver has at least BSN preferred, some positions list BSN preferred and BSN required within 2-3 years of hire. One hospital that is not a university hospital will no longer hire ASNs even with experience. The rural hospitals have "BSN preferred for new grad positions at least.

I did not say that "only hospitals affiliated with BSN granting Universities prefer BSNs", I stated that if you intend on working at an academic hospital, then a BSN is definitely worthwhile. This varies from area to area, it's not really accurate to take a characteristics specific to a local area and generalize it to the entire country. What RN's in your area and what RN's in my area experience might be very different.

Conspiracy theories are ideas that are unproven and often seem far fetched. The idea that Universities see some benefit in increasing demand for their own product came from the Dean of a local BSN program, not some paranoid delusion. While we're on the subject of conspiracy theories though, we recently had a large consulting group come through. They identified that we could save money by increasing RN FTE's, and suggested one way of doing this was to hire more BSN's, as they often need to make more money due to higher loan amounts.

In major urban centers, where most if not all hospitals have some sort of affiliation with a University, you will benefit from a BSN, however not all Nurses intend on working in major Urban centers.

It's important to understand the motivations of many (but not all) employers who require or prefer BSN's as this has been seen by many as a sign that all employers see significant differences in ADN and BSN graduates, and therefore it only makes sense to do away with ADN programs. Understanding the reasoning behind this demand helps us make more appropriate decisions in how we manage our profession.

So if it's up to you, how would you change Nursing education?

Last edit by MunoRN on Nov 18, '12

Nov 18, '12

Leaving aside many of the other great points made in this thread, one feels the number of hospitals going "BSN preferred" or even required is simply because they can.

The same forces that have impacted college education are felt by four year nursing programs; that is there simply are more ways to fund such an education than historically possible. Even if this means going into debt many students in particular younger ones see a four year college degree as some sort of right of passage regardless of the major. Indeed often it seems the choice of major and or employment post graduation seems to rank lower on the scale than other factors.

It is even possible to take out debt for ABSN programs which again increases the number of total BSN graduates in the market.

Couple the rise of four year grads with shrinking inpatient beds in many areas of this country and you've got a glut of nurses all chasing the few openings that are available.

In the past mandating the BSN has failed often because it caused staffing shortages. Hospitals had to come off their high horses and start hiring ADN/diploma grads to get feet on the floors. Have a very funny feeling this time at least in certain areas of the country this time the BSN mandates will stick, well at least for top tier facilities.

Here in NYC for example about ten or more hospitals have closed over the past eight or so years and unless things turn around financially a few more (mostly in Brooklyn) are probably going to fall as well. Yet there has not been a corresponding decrease in the local nursing education market. Indeed new programs are opening (Swedish Massage Institute), including lots of ABSN programs.

Even having the coveted BSN is no promise of a gig around here either. Hospitals are being picky on that level and turning down new grad BSNs and or letting them go before their orientation is over.

All the advertising and promotion over "Magnet Status" isn't helping either.

Leaving aside many of the other great points made in this thread, one feels the number of hospitals going "BSN preferred" or even required is simply because they can.
. . .
Couple the rise of four year grads with shrinking inpatient beds in many areas of this country and you've got a glut of nurses all chasing the few openings that are available. . .

In the past mandating the BSN has failed often because it caused staffing shortages. Hospitals had to come off their high horses and start hiring ADN/diploma grads to get feet on the floors. Have a very funny feeling this time at least in certain areas of the country this time the BSN mandates will stick, well at least for top tier facilities.

Here in NYC for example about ten or more hospitals have closed over the past eight or so years and unless things turn around financially a few more (mostly in Brooklyn) are probably going to fall as well. Yet there has not been a corresponding decrease in the local nursing education market. Indeed new programs are opening (Swedish Massage Institute), including lots of ABSN programs.

Even having the coveted BSN is no promise of a gig around here either. Hospitals are being picky on that level and turning down new grad BSNs and or letting them go before their orientation is over.

All the advertising and promotion over "Magnet Status" isn't helping either.

I think this describes the situation in many, if not most of the major urban areas. In my own sleepy suburb of NYC and Washington, DC - otherwise known as Philadelphia - "BSN preferred" is an endangered species of job posting, having been nearly completely eradicated by the the oppotunistic onslaught of the non-native species, "BSN required." The prospects for the total obliteration of the former are very good, given the record numbers of nursing school graduates combined with low levels of nursing job creation.

The ANA probably didn't see their vision of the BSN as the minimum nursing credential being made manifest in quite this fashion, but manifest it is and frankly, it's hard to see the ADN surviving for much longer, except in some of the more medically underserved areas. Having final realized this cherished dream, the ANA can now concentrate on their new vision: Making the DNP the minimum credential for nurse practitioners.

Nov 18, '12

I believe in getting BSN as entry. Research shows that death rates are lower for the patients who were taken care by BSN or higher educated nurses. I have read this on my books. Plus, BSN is considered to be what makes you a "professional".

I believe in getting BSN as entry. Research shows that death rates are lower for the patients who were taken care by BSN or higher educated nurses. I have read this on my books. Plus, BSN is considered to be what makes you a "professional".

Oh really?

New York State has been listing Registered *Professional* Nurses by statue for decades now, it says so clearly in the practice act. That designation applies regardless of type of education (diploma, ADN or BSN).

Why can't there be a third level of licnesure? The ADN can still result in sitting for the NCLEX-RN, and grads of a BSN can sit for.... Something else. A scope of practice higher than the current RN? In any case, having multiple educational pathways for the *exact* same licensure is illogical and confusing.

*** the reason there can't be a third leve of license is what are you goig to to test the BSN grads on? What will they know that the ADNs won't about nursing?
Having a variety of educational paths seems perfectly logical to me and I believe is a huge assest to nursing.

we recently had a large consulting group come through. They identified that we could save money by increasing RN FTE's, and suggested one way of doing this was to hire more BSN's, as they often need to make more money due to higher loan amounts.

*** I once heard the CNO of a large, multi hospital health system say that BSNs were prefered (in reference to hiring new grads) as they were seen as "less likely to rock the boat' (her exact words) related to their large amount of student and other debt. There was some discussion about how now that there were a dozen nurses lined up for every open position there were going to be some changes, changes that nurses were not going to like. New grad ADNs were seen as more likely to vote with their feet under worsening working conditions.
I had attended a high level meeting to present some data. When I finished, on my way out a good friend of mine who was head of nursing at one of the smaller hospitals in the system invited me to sit at her table and enjoy the large and fancy free buffet that had been laid out for the meeting. I sat unobserved in the corner and heard some shocking things in the meeting, things that lead me to immediatly start looking for another job. I think I was the only nurse below department head in the room. Even unit managers where not part of the meeting. I remain employed with this system on a part time basis but found a full time job in a different system. This was in 2010.

MunroRN, your contention that only hospitals affiliated with BSN granting Universities prefer BSN's not only sounds like a conspiracy theory, it doesn't reflect reality.

*** If MunroRN ever said that I can't find it. Can you provide the quote please?

Nov 18, '12

Again, for some the BSN will improve your job outlook, but not for all. Data on job prospects is somewhat limited, although there's quite a bit available for Arizona. In a survey of newly licensed Nurses by the AZ BON.

"There were few differences in percentages between practicing and non-practicing RNs in terms of educational preparation in 2012. Thirty-five percent of practicing nurses are BSN prepared as compared to 31 percent of non-practicing nurses indicating little preference among all employers for BSN prepared nurses. Associate degree nurses comprise a slightly larger percentage (67%) of the non-practicing nurse population than the overall sample population (65%). "

This doesn't mean however that there aren't advantages to BSN prepared Nurses, so the question is how do we do that. Many BSN programs already suffer from overburdened clinical placement, so then how do we double the size of BSN programs and maintain educational quality with significantly limited clinical opportunity?

I believe in getting BSN as entry. Research shows that death rates are lower for the patients who were taken care by BSN or higher educated nurses. I have read this on my books. Plus, BSN is considered to be what makes you a "professional".

But the Op explained that while The mortality rates are somewhat (not overwhelmingly) lower for patients who were taken care of by BSN's vs ADN's, the hospitals who had these BSN "Super Nurses" worked in facilities that had more and better resources on hand to treat these patients with vs the "Lowly" ADN trained nurses who worked at facilities that were not quite so blessed with the latest and greatest...

I Have 7 friends who are BSN's, and before I decided to participate in this discussion I spoke with them about this topic (I'm merely a pre-req student at this time, and I hate giving my opinion about something unless I do a little research on it ). They do not all know each other as I met most of them at different times in my life, as well as in different places. Their general consensus on this topic was this;

1. They ALL have as a goal to become NP's, so it were necessary for them to get their BSN's anyway enroute to obtaining that goal.

2. They all agreed that unless I (I asked them the questions as if they pertained to me, since I am a friend to them I assumed that the advice they gave would be more genuine, and not the expected "Education is always important crap") had planned on going into a management position before obtaining my MSN (and in effect slowing myself down), my best bet would be to get my ADN, find work and then complete a Bridge program. Interestingly and as a side note, two of them told me to be absolutely certain to get into a bridge program that provides a BSN on the way to the MSN, so just in case my plans get derailed for a time, I will have something to show for it. This is how they would do it if they "Knew then what they know now." They all just went straight to BSN programs from the start.

3. When I asked them if, in their honest opinion a new grad BSN was a better nurse than a new grad ADN, they agreed that at first, "NO!" no it doesn't. But they did concede that down the road it would make them more versatile to their hospitals.

Also, as far as that coveted "Professional" status, please see my earlier post on page 5.

Why can't there be a third level of licnesure? The ADN can still result in sitting for the NCLEX-RN, and grads of a BSN can sit for.... Something else. A scope of practice higher than the current RN? In any case, having multiple educational pathways for the *exact* same licensure is illogical and confusing.

Agreed.

Personally, If a BSN became the new entry level standard for Nursing, I would be OK with that provided the scope of practice along with the pay in creased Commensurately. The problem today is, well you said it yourself that BSN grads have nearly NO financial incentive (I'm sorry, but they can keep their extra .50 to $1.00/hr raise), and no professional incentive (as ADN and BSN are limited to the same scope of practice).

NOW, Lets say the hourly raise in enough to pay for the additional cost of the BSN in 1 yr to 18 months tops (with no overtime), and the BSN's scope increased to include those things that experienced RN's KNOW they are capable of doing but can't (you guys would know those things better than I-I'm pre-req, remember ), then I'd say "Sure, lets do it!"

Other than that, I just don't see how it could be justified after decades of outstanding ADN's prove that it just isn't necessary...

*** I once heard the CNO of a large, multi hospital health system say that BSNs were prefered (in reference to hiring new grads) as they were seen as "less likely to rock the boat' (her exact words) related to their large amount of student and other debt. There was some discussion about how now that there were a dozen nurses lined up for every open position there were going to be some changes, changes that nurses were not going to like. New grad ADNs were seen as more likely to vote with their feet under worsening working conditions.
I had attended a high level meeting to present some data. When I finished, on my way out a good friend of mine who was head of nursing at one of the smaller hospitals in the system invited me to sit at her table and enjoy the large and fancy free buffet that had been laid out for the meeting. I sat unobserved in the corner and heard some shocking things in the meeting, things that lead me to immediatly start looking for another job. I think I was the only nurse below department head in the room. Even unit managers where not part of the meeting. I remain employed with this system on a part time basis but found a full time job in a different system. This was in 2010.

Thank you for sharing this inside info into what is going on in your system and obviously is a blue print for many other systems as well. They all seem to jump on the bandwagon with the same strategy and plans like hourly rounding, scripting, etc. It gives people a warning of what to expect, to try to prepare and hopefully thru increased unionization have some control over working conditions. Without unions you really have no real say in working conditions and even if you are blessed with good conditions it could change in an instant and then your only recourse is to vote with your feet or stay put and struggle!

Where I live we have RN's from ADN, BSN to direct entry masters RN NP programs and at least half the staff are on their way to getting an NP and will leave the hospitals as soon as they are able. I work with agency nurses who have shared their experiences at other hospitals and systems. A pattern emerges of getting rid of older staff, increasing the workload till there is a lot of turnover and then eventually reversing course and improving working conditions after they have either achieved their original goal or decided the turnover was too much. Those who have unions should thank their lucky stars that they at least have a say in working conditions!